1. PATIENT PRESENTATION
A 66‐year‐old man visited our hospital with complaints of pharyngeal discomfort and dysphagia for 3 years. Endoscopic examination revealed a large mass concealing the larynx (Figure 1). Computed tomography revealed a 40 × 30 mm mass located at the base of the epiglottis (Figure 2). Although the patient did not require emergency airway management, it would have been fatal for the patient to develop acute epiglottitis in the future. Therefore, the patient was scheduled for early mass removal. Because the patient could not be intubated due to the large mass, we performed a tracheotomy followed by removal of the mass using endoscopic laryngomicrosurgery (Figure 3). The tracheocutaneous fistula was closed on the day after surgery. The patient's symptoms resolved after the surgery.
FIGURE 1.
Endoscopy shows a large mass concealing the epiglottis and vocal cords.
FIGURE 2.
Computed tomography shows a cyst located at the base of the epiglottis.
FIGURE 3.
Excised epiglottic cyst.
2. DIAGNOSIS
2.1. Large epiglottic cyst
Laryngeal cysts are uncommon, accounting for 5% of benign laryngeal lesions, 1 and approximately 50% of laryngeal cysts are epiglottic cysts. 2 Epiglottic cysts are often asymptomatic and are detected incidentally during laryngoscopy. However, they may become infected and cause acute epiglottitis. Removal of large epiglottic cysts should be considered because of the risk of airway obstruction and acute epiglottitis. When a pharyngeal mass is seen on computed tomography, the differential diagnosis includes a tumor, foreign body, or laryngeal cyst. Patients with pharyngeal masses and dyspnea should be evaluated for airway compromise. Endoscopic examination is an excellent tool to assess the severity of airway obstruction and should be performed in conjunction with an otolaryngologist. In patients with airway obstruction, a tracheostomy is often required.
Ominato H, Komabayashi Y. Man with pharyngeal discomfort and dysphagia. JACEP Open. 2023;4:e12995. 10.1002/emp2.12995
REFERENCES
- 1. Collins AM, Chapurin N, Lee WT. Epiglottic cyst causing dysphagia and impending airway obstruction. Am J Otolaryngol. 2015;36(3):492‐493. doi: 10.1016/j.amjoto.2015.02.002 [DOI] [PubMed] [Google Scholar]
- 2. DeSanto LW, Devine KD, Weiland LH. Cysts of the larynx–classification. Laryngoscope. 1970;80(1):145‐176. doi: 10.1288/00005537-197001000-00013 [DOI] [PubMed] [Google Scholar]